Provider Demographics
NPI:1265486526
Name:SACCUCCI, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:SACCUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:55 VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02879-8274
Mailing Address - Country:US
Mailing Address - Phone:401-272-2020
Mailing Address - Fax:401-789-4113
Practice Address - Street 1:55 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-8274
Practice Address - Country:US
Practice Address - Phone:401-272-2020
Practice Address - Fax:401-789-4113
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
720117301OtherCIGNA
050369447OtherVISION SERVICE PLAN
RI2200163OtherUNITED HEALTHCARE
2847OtherNEIGHBORHOOD HEALTH
001976OtherBLUE CHIP
0550481OtherAETNA HMO
7389920002OtherCIGNA PAL #
410033599OtherRAILROAD MEDICARE
5714177OtherAETNA NON HMO
RIMS00823Medicaid
RI324OtherBLUE CROSS BLUE SHIELD
050369447OtherVISION SERVICE PLAN
RI007000168Medicare ID - Type Unspecified